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The Impact of Invasive Brain Oxygen Pressure Guided Therapy on the Outcome of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

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Abstract

Traumatic brain injury (TBI) is a major public health burden, causing death and disability worldwide. Intracranial hypertension and brain hypoxia are the main mechanisms of secondary brain injury. As such, management strategies guided by intracranial pressure (ICP) and brain oxygen (PbtO2) monitoring could improve the prognosis of these patients. Our objective was to summarize the current evidence regarding the impact of PbtO2-guided therapy on the outcome of patients with TBI. We performed a systematic search of PubMed, Scopus, and the Cochrane library databases, following the protocol registered in PROSPERO. Only studies comparing PbtO2/ICP–guided therapy with ICP-guided therapy were selected. Primary outcome was neurological outcome at 3 and 6 months assessed by using the Glasgow Outcome Scale; secondary outcomes included hospital and long-term mortality, burden of intracranial hypertension, and brain tissue hypoxia. Out of 6254 retrieved studies, 15 studies (n = 37,245 patients, of who 2184 received PbtO2-guided therapy) were included in the final analysis. When compared with ICP-guided therapy, the use of combined PbO2/ICP–guided therapy was associated with a higher probability of favorable neurological outcome (odds ratio 2.21 [95% confidence interval 1.72–2.84]) and of hospital survival (odds ratio 1.15 [95% confidence interval 1.04–1.28]). The heterogeneity (I2) of the studies in each analysis was below 40%. However, the quality of evidence was overall low to moderate. In this meta-analysis, PbtO2-guided therapy was associated with reduced mortality and more favorable neurological outcome in patients with TBI. The low-quality evidence underlines the need for the results from ongoing phase III randomized trials.

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Authors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium

    Elisa Gouvêa Bogossian, Alberto Diosdado, Filippo Annoni & Fabio Silvio Taccone

  2. Department of Neurosurgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Sami Barrit, Mejdeddine Al Barajraji & Sophie Schuind

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  1. Elisa Gouvêa Bogossian
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  2. Alberto Diosdado
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Contributions

AD, EGB, and FST conceived the study; AD, SM, and MAB performed the screening and selected the articles for the systematic review. AD, EGB, and FA extracted the data from the articles; EGB and FST conducted the statistical analysis. AD, EGB, and FST wrote the first draft of the article; FA, SS, SM, and MAB revised the text for intellectual content. All authors read and approved the final manuscript.

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Correspondence to Elisa Gouvêa Bogossian.

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Gouvêa Bogossian, E., Diosdado, A., Barrit, S. et al. The Impact of Invasive Brain Oxygen Pressure Guided Therapy on the Outcome of Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Neurocrit Care 37, 779–789 (2022). https://doi.org/10.1007/s12028-022-01613-0

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